Confirm site & histology
A renal cell carcinoma is not staged like renal pelvis urothelial cancer. Exocrine pancreatic carcinoma is not a pancreatic neuroendocrine tumor.
See what changes the stage.
Compare one factor at a time. These are separate teaching scenarios, not a timeline of disease progression.
ANATOMY → TNMInteractive schematic
Primary extent Regional spread Distant spread
Original diagrams, not to scale. Node and distant-site symbols do not represent exact counts or a complete anatomical map.TNM reference
Select a category or matrix cell to apply it in Use.
NONMETASTATIC REFERENCE MATRIXM0 assumed for this reference only
Study notes
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Practice cases
Decide on TNM and stage, then reveal the answers.
Three categories. One site-specific rule.
TNM categories are looked up together, not added.
1FindingsSize, extent, nodes, distant sites
2CategoriesSite-specific T, N and M
3ModifiersWhen required: age, PSA, grade
4Stage groupApply the correct edition
Build the evidence
Choose the system & timing
Use the correct edition for the diagnosis date and jurisdiction. This atlas implements the displayed AJCC version, not a universal UICC TNM9 system.
Assign T, N and M
Use the relevant examination, imaging, operative and pathology findings. T measures local extent; N describes the site’s regional basin; M describes distant disease.
Add required modifiers
Prostate needs PSA and Grade Group. Differentiated thyroid needs age at diagnosis. Breast prognostic staging needs biomarkers and grade beyond this anatomic module.
Apply the stage grouping
Match the full combination to the site’s rules. Review discordant or incomplete findings. Stage IV need not mean M1, and M1 need not always mean IV.
Document the reasoning
Record site, histology, edition, classification, categories, stage and evidence. Keep the original diagnosis stage when describing subsequent treatment response.
Read the prefix before the number.
Clinical
Initial assessment before treatment, including examination, imaging and diagnostic biopsies. A biopsy does not automatically make the whole case pathological.
Pathological
Appropriate surgical/pathological assessment combined with the clinical evidence. A negative distant assessment is cM0: pM0 is not a valid category.
Post-neoadjuvant
After initial systemic/radiation treatment, assessed clinically or after surgery. This calculator does not assign post-neoadjuvant stage groups.
Stage ≠ grade ≠ treatment response.
Stage describes disease extent and, in some systems, prognostic factors. Grade describes tumor differentiation or aggressiveness. RECIST describes changes in tumor measurements over time. None can substitute for the others.